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Varicella Zoster
varicella zoster blisters

Shingles is a disease caused by the varicella-zoster virus, which is the same virus that causes chickenpox. After chickenpox illness, the virus lies dormant in certain nerve tissue. As people age, it is possible for the virus to reappear in the form of shingles. Shingles is more common in people 50 years of age and older and in people who have weak immune systems. Up to 1 million cases of shingles occur each year in the United States.

A shingles rash usually appears on one side of the face or body and follows along the nerve root. The rash lasts from 2 to 4 weeks. The main symptom of shingles is pain, which can be quite severe and persist even after the rash is gone. Other symptoms include fever, headache, chills and upset stomach.

Treatment of shingles focuses on shortening the length of illness and pain relief. Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, are used to help shorten the length of illness. Pain medications, including topical medications, are used to help relieve the pain associated with shingles.

About the Vaccine

There is only one shingles vaccine. It is a live, attenuated vaccine.

Shingles Vaccines Licensed for Use in the U.S.

Product: Zostavax® (Shingles)
Manufacturer: Merck & Co.
Year licensed: 2006
Product Insert

Indications Contraindications and precautions
  • People 50 years of age and older.
  • People who have had a severe allergic reaction to a shingles vaccine component.
  • People who are moderately or severely ill should wait until recovery before receiving any vaccine. Minor illnesses, such as a cold, are not a contraindication.
  • People who are immune compromised due to disease, treatment, or medication.
  • Women who are pregnant or planning pregnancy within 4 weeks.
  • Shingles vaccination is not recommended for persons of any age who have received varicella (chickenpox) vaccine.
  • People taking chronic acyclovir, famciclovir, or valacyclovir should discontinue these medications at least 24 hours before administration of zoster vaccine, if possible. These medications should not be used for at least 14 days after vaccination.
Vaccine Dose/Route Routine Administration Schedule
Zostavax Dose: 0.65 mL

Route: Subcutaneously
Single dose     
Shingles Vaccine Side Effects
  • Redness, soreness, swelling, or itching at the injection site (1 in 3 people).
  • Headache (1 in 70 people).
  • Severe allergic reaction (very rare).
Product Name Supplied Storage and Handling
Merck & Co.
0.65 mL single dose vial with diluent (1 and 10 sets per package). Zostavax should be stored frozen at a temperature of -15°C (+5°F) or colder until it is reconstituted for injection. Protect from light. Zostavax may be stored and/or transported at refrigerator temperature (2 to 8°C, 36 to 46°F) for up to 72 continuous hours prior to reconstitution. Reconstituted vaccine must be used within 30 minutes. Diluent can be stored in the refrigerator or at room temperature. Diluent should not be frozen.

Zostavax is a semi-hazy to translucent, off-white to pale yellow liquid.     
The webinar series will provide an overview of the principles of vaccination, general recommendations, immunization strategies for providers, and specific information about vaccine-preventable diseases and the vaccines that prevent them. This is a live, 15 week, online series.
02 Jan 14

Sample Q&A: The Disease

Is there a treatment for shingles?

Although viral diseases can't be cured, doctors can prescribe oral antiviral medications, such as Zovirax® (acyclovir), Famvir® (famciclovir) and Valtrex® (valacyclovir), that help control the infection by hindering reproduction of the virus in the nerve cells. Antiviral drugs may also help prevent the painful after-effects of shingles known as postherpetic neuralgia or PHN. Other treatments for PHN include steroids, antidepressants, anticonvulsants, and topical agents.

To relieve pain, the doctor may recommend over-the-counter analgesics (pain-relieving drugs), such as ibuprofen and naproxen, or prescription drugs, such as indomethacin, all members of a class of medications known as nonsteroidal anti-inflammatory drugs. Acetaminophen is also commonly used to relieve the pain. If pain is severe, doctors may add stronger analgesics, such as codeine or oxycodone. If any of the blisters become infected it may take longer for the site to heal. Infections may be treated with antibiotics, in the form of a cream, or taken by mouth.

In the case of ophthalmic herpes zoster, treatment is likely to involve specific anti-viral eye drops, and possibly treatment by mouth as well. In the event of long-lasting pain (PHN), a pain specialist could be consulted.

Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Merck 31 Aug 07
Information on Shingles and Postherpetic Neuralgia
Information Paper
Package Insert - Vaccine
Merck 31 Aug 07
Information on Shingles and Postherpetic Neuralgia
New shipping package for ZOSTAVAX from Merck Vaccines (replacing the use of dry ice with 6 refrigerant packs)
MMQC-11-1404 15 Jun 11
Vaccine Information Statement